The use of primary Human Papillomavirus (HPV) testing for cervical screening in New Zealand (A service evaluation project)

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Women enrolled in the National Cervical Screening Programme (NCSP) present for regular cervical smears (cytology) to screen for early cervical abnormalities (precancer). Nearly all cervical cancers are now known to be caused by certain types of human papillomavirus (high risk human papillomavirus, hrHPV). In 2009 New Zealand introduced an HPV immunisation program for young women against the 2 most common HPV types. Cervical screening is currently a cost effective intervention in New Zealand, but this will become progressively less so as HPV immunisation uptake increases. Changes to the NCSP will be required to improve cost effectiveness in the context of HPV immunisation, but any such changes cannot be made without evaluation of new technologies and processes. Overseas studies have shown that primary HPV screening is more sensitive in detecting precancerous lesions than cytology, can be performed less frequently, is more costeffective in countries with an HPV immunization program, such as NZ and may require fewer colposcopy referrals. Several developed countries are moving to implement or pilot hrHPV testing,. This project will examine the use of HPV as a primary screening test over a one year period with respect to: 1. Acceptability of the change to women 2. Changes to the NZ Cervical Screening Guidelines 3. Education of colposcopists, GPs and nurses about HPV testing in respect to interpretation of results, referral and management of women with abnormal results 4. Laboratory processing of specimens including time and motion studies 5. Requirements for associated information technology changes including to the NCSP register The study has some similarities to a larger Australian study, conducted by the University of New South Wales and Victorian Cytology Service, which will test 5000 women. For some analyses, results will be pooled with the Australian study